EVALUATION OF HEALTH THREATS: How the EU system functions Zsuzsanna Jakab, Director of ECDC, Informal Meeting of Health Ministers

Transcription

1 EVALUATION OF HEALTH THREATS: How the EU system functions Zsuzsanna Jakab, Director of ECDC, Informal Meeting of Health Ministers Angers, 8 9 September 2008 ecdc.europa.eu

2 Key message of presentation ECDC is part of a strong and effective EU system for detecting, assessing and assisting in response to health threats. The reason the system may not always be so visible to you is that it is working well!

3 Infectious diseases still a threat to Europe in the 21st century

4 14th century Europe: The black death Angers

5 Epidemics still happen in our era SARS in 2003 spread internationally at alarming speed 20th century saw influenza pandemics in 1918, 1957 and 1968.

6 Europeans still die of infectious diseases (1) According to ECDC s analysis, each year in the EU approximately 4 million people catch healthcare-associated infections: 37,000 deaths directly attributable to healthcareassociated infections 25 to 50 million people catch influenza: 40,000 to 200,000 deaths from seasonal influenza

7 Europeans still die of infectious diseases (2) According to ECDC s analysis, each year in the EU around 90,000 people diagnosed with tuberculosis: 7,800 deaths from tuberculosis approximately 30,000 people diagnosed with HIV/AIDS: 1,800 deaths from AIDSrelated diseases upsurge of measles in EU in 2007/2008 (nearly 4,000 cases in Q1 2008): reporting delay, but there will be deaths attributable to measles

8 21st century trends Emerging/re-emerging infectious diseases: Emerging pathogens (e.g. Chikungunya, BSE-v/CjD, Ebola, H5N1) Resurgence of TB, measles, dengue, meningitis Animal to humans (e.g. Nipahvirus, hanta virus, H5N1) Change presents microbes with new opportunities: Globalisation of travel and trade Intentional use of biological agents (e.g. anthrax) Climate change

9 Microbes thrive and spread Environment Antibiotics Animals Climate change Pollution Exploitation Zoonosis Human Food production Mega-cities Migration Population growth Vectors Vector proliferation Vector resistance Intensive farming Transmission

10 Expanded Europe the five freedoms in the EU 1. Free movement of people * 2. Free movement of services * 3. Free movement of goods * 4. Free movement of monies * 5. Free movement of microbes * Adapted from Summary of Legislation Internal Market

11 ECDC s role in the EU health security system

12 The EU health security system: conceptual overview Communication Risk monitoring Risk assessment Monitor information and health threats Assess risks, build knowledge and capacity Investigate alerts, issue scientific advice, provide support Risk management Implement control measures ECDC and Member States EC and Member States

13 Risk assessment vs. risk management A complex interrelation Risk assessment Risk management

14 ECDC s threat detection framework Indicator-based surveillance Event-based surveillance Identified risks Mandatory notification Laboratory surveillance Emerging risks Syndromic surveillance Mortality monitoring Health care activity monitoring Prescription monitoring 'Surveillance' systems Collect, analyse, interpret Assess Data Signal Events Capture, filter, verify Event monitoring Domestic Media review EI focal points International Info-scanning tools Distribution lists International agencies Non-healthcare based Poison centres Behavioural surveillance Environmental surveillance Veterinary surveillance Food safety/water supply Drug post-licensing monitoring Investigate Public health alert Control measures Disseminate Early Warning and Response System Rapid inquiries (Enternet) E-alerts (Eurosurveillance) Int'l Health Regulations (WHO) Threat bulletin (ECDC) WEB

15 The system of EU disease surveillance before ECDC a multitude of networks DSN DSN DSN DSN DSN DSN DSN DSN DSN DSN DSN Impact for Member States Huge workload Different interfaces for data upload Different database formats Impact for networks Data cleaning effort for all Member States Feedback for all Member States

16 The new European surveillance systems: a one-stop shop Data upload and access by Member States () TESSy The European Surveillance System Data access by Data users in Member States National institutes Disease experts General public Advisory Forum members Management Board members WHO EMCDDA EFSA Commission Others

17 Epidemic intelligence and threat detection Monitoring and assessing signals of threats 24/7 Assisting the Commission and the Member States by operating of the EWRS in ECDC premises Link to other EU rapid alert systems (e.g. food safety) Threat Tracking Tool in place Production of weekly epidemiological bulletins for Member States and the Commission Preparing threat assessments for emerging threats

18 Epidemic intelligence in action Enhancement of epidemic intelligence during the Beijing Olympic Games Scanning of Chinese news source with Chinese keywords Daily round ECDC table meeting on threats accessible to Member States Daily bulletin produced 26 events detected and assessed

19 Some outputs of ECDC activities Website updates and Weekly Threat Report (restricted access) Annual Epidemiological Report Risk assessments Scientific guidance and development of knowledge base Hands-on technical support, when requested

20 Risk assessment and analysis Networking Europe s health knowledge Analysing and assessing threats Presenting options and expert advice

21 Building Member States capacity and preparedness Capacity building through training European Programme for Intervention Epidemiology Training (EPIET) Short courses for senior officials Country visits Simulation exercises Implementation of the Emergency Operation Centre (EOC) Possible use of EU Structural Funds? EPIET courses train field epidemiologists from across the EU

22 Case study infectious TB on cargo ship (July 2008) Suspected TB case on cargo ships travelling from Romania to France via Turkey Romanian authorities notify EC and ECDC through the EWRS ECDC assesses risk to crew members Information shared with EU Member States, WHO, the European Maritime Safety Agency and Turkey Patient taken into care and tested in Turkey Ship tracked through the Bosporus and patient evacuated by Turkish authorities Positive test results shared with EC, ECDC and Member States Crew members screened for TB in France Clinical check-up and chest X-ray Ship departs before all test results available Health authorities in next port of call notified

23 ECDC role in supporting EU health security Identify, assess and communicate current and emerging health threats to human health from communicable diseases. (ECDC Founding Regulation (851/2004), Article 1) This encompasses: detection of health threats; EU-level disease surveillance; epidemic intelligence; risk assessment; early warning and response; scientific studies and guidance; technical assistance and training; and communication.

24 Prevention and preparedness reinforce EU health security

25 ECDC contribution to health security Prevention Training Preparedness Scientific Communication Health determinants Prevention (AMR, VPD) Early warning Epidemic Intelligence Rapid Alert Risk Assessment Public Communication Surveillance EU Surveillance Support to Risk Management Outbreak Communication Outbreak Assistance

26 Building the knowledge base ECDC s disease-specific programmes Respiratory tract infections (influenza, tuberculosis) Sexually transmitted infections including HIV and blood-borne viruses Vaccine-preventable diseases Antimicrobial resistance and healthcareassociated infections Food- and water-borne diseases Emerging and vector-borne diseases

27 ECDC assessment of EU preparedness against pandemic influenza five major gaps Huge progress since 2005, but five major gaps in preparedness across EU Local preparedness Intersectoral work Interoperability Research that is more targeted Improving use of seasonal vaccine and developing pandemic vaccine capacity

28 Local preparedness: most countries are challenged by ECDC s local acid test Are you convinced that you can deliver and manage your stocks of antivirals in the hour window, manage the stocks and not run out? distribute specific pandemic vaccines efficiently and equitably when they start to become available? maintain local essential services?

29 Good news There has been massive progress since Every Member State has a plan and many have advanced further. Many innovations and developments at the Member State and EU level. Some Member States are working at all levels, down to the local level. Multi-sectoral approaches. Bad news Difficult to maintain momentum ('Flu fatigue ). Only 12 Member States had a national contingency plan for maintaining essential services. One third of countries were yet to work with neighbouring countries. While 19 Member States had held a national health sector exercise, far fewer had had any multi-sectoral Antiviral stockpiles do not now encompass the issue of antiviral resistance. We need another two or three years of hard work.

30 Conclusions of the external evaluation of ECDC Key conclusion: ECDC is capable of supporting EC and Member States in dealing with current threats and in the event of a major crisis ECDC has added value at the EU level Presence on the international stage Building good working relationships ECDC is perceived to be relevant and important ECDC is an independent centre of scientific excellence ECDC made a significant contribution to fighting against communicable diseases

31 Partnerships for health security

32 All partners contribute to health security Member States Networks Council EU agencies Commission and ECDC EP Industry WHO Research Community NGOs Other countries CDCs

33 EU partnership with WHO Collaboration and coordination in health security Surveillance and Reporting Threat detection and alerts Outbreak response Health communication Mutual access to IHR/EWRS strengthens another link

34 We're making sure our citizens sleep safe and sound.